Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

What score should be used for evaluation of Crohn's disease severity using magnetic resonance imaging?

What score should be used for evaluation of Crohn's disease severity using magnetic resonance imaging

What is the role of diffusion-weighted imaging in ileocolonic Crohn's disease?

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Factors influencing acute infusion reactions in inflammatory bowel disease patients treated with infliximab in the era of scheduled maintenance therapy

International audienceBackground : An acute infusion reaction during infliximab infusions could lead to drug withdrawal and limit the therapeutic armamentarium in inflammatory bowel diseases Aim : To determine the risk and protective factors of an acute infusion reaction. Materials and methods : Data were retrieved retrospectively from electronic charts of patients from the 'Clermont-Ferrand IBD cohort'. Results : Among 80 patients, including 51 (63.8%) patients with Crohn's disease, 23 (28.8%) experienced an acute infusion reaction. In multivariate analysis, the Crohn's disease nonstricturing nonfistulizing phenotype predicted an acute infusion reaction (odds ratio= 11.40, 95% confidence interval 1.5-87.6; P= 0.019). Among 1107 infusions, we observed 38 acute infusion reactions (3.4%). In multivariate analysis, only resumption of infliximab after drug holiday was a major risk factor (odds ratio= 24.87, 95% confidence interval 4.4-140.0; PConclusion : An acute infusion reaction is a major event in the history of inflammatory bowel diseases patients treated with infliximab as it could lead to drug discontinuation and thus limits the therapeutic armamentarium considerably. The resumption of infliximab after drug holiday is a major risk factor for an acute infusion reaction. Premedication efficacy remains questionable and should be limited to these high-risk patients

Diffusion-weighted magnetic resonance entero-colonography is highly effective to detect endoscopic ulcerations in ileocolonic Crohn's disease

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Analytic Video (2D+T) Signals by Clifford Fourier Transforms in Multiquaternion Grassmann-Hamilton-Clifford Algebras

International audienceWe present an algebraic framework for (2D+ t) video analytic signals and a numerical implementation thereof using Clifford biquaternions and Clifford–Fourier transforms. Though the basic concepts of Clifford–Fourier transforms are well known, an implementation of analytic video sequences using multiquaternion algebras does not seem to have been realized so far. After a short presentation of multiquaternion Clifford algebras and Clifford–Fourier transforms, a brief pedagogical review of 1D and 2D quaternion analytic signals using right quaternion Fourier transforms is given. Then, the biquaternion algebraic framework is developed to express Clifford–Fourier transforms and (2D + t) video analytic signals in standard and polar form constituted by a scalar, a pseudoscalar and six phases. The phase extraction procedure is fully detailed. Finally, a numerical implementation using discrete fast Fourier transforms of an analytic multiquaternion video signal is provided

Systematic review with meta-analysis: Anti-TNF therapy in refractory pouchitis and Crohn's disease-like complications of the pouch after ileal pouch-anal anastomosis following colectomy for ulcerative colitis

International audienceBackground: Inflammatory complications including chronic refractory pouchitis and Crohn's disease (CD)-like complications of the pouch are common complications after ileal pouch-anal anastomosis (IPAA) following colectomy for ulcerative colitis (UC). We performed a systematic review and meta-analysis to evaluate the efficacy of anti-TNF therapy in distinguishing patients with chronic refractory pouchitis from those with CD-like complications of the pouch. Methods: We performed a systematic literature search to identify articles and abstracts reporting anti-TNF agents efficacy in treating inflammatory complications of the pouch after IPAA for UC. Short-term and long-term remissions were evaluated at 8 weeks 95% CI[5-10] and 12 months 95% CI[12-18.5], respectively. Results: We identified 21 articles and 3 abstracts including 313 patients treated either with infliximab (n = 194) or adalimumab (n = 119) for inflammatory complications of the pouch. The rates of short-term and long-term clinical remission were 0.50 (95% CI [0.37-0.63]; I-2 = 0.57) and 0.52 (95% CI[0.39-0.65]; I-2 = 0.59), respectively. The rate of remission after anti-TNF induction therapy seemed to be higher in CD-like complications of the pouch 0.64 (95% CI[0.5-0.77]; I-2 = 0.18), compared to refractory pouchitis 0.10 (95% CI [0.00-0.35]; I-2 = 0.00) (P = 0.06), whereas no such difference appeared after long-term maintenance therapy 0.57 (95% CI[0.43-0.71]; I-2 = 0.32) and 0.37 (95% CI [0.14-0.62]; I-2 = 0.47), respectively (P = 0.57). Sensitivity analyses suggested no difference in outcomes. No significant publication bias has been detected. Conclusion: Anti-TNF agents have a clear trend to have higher and faster efficacy in CD-like complications of the pouch compared to refractory pouchitis, highlighting the need to differentiate these two entities both in daily practice and clinical trials